The holder whose full name is TAVERNA, VITO,come from RIDGEWOOD NY,hold the Physician license(NO.01032492A) which status is Expired Non-Renewable.
| Name | TAVERNA, VITO |
|---|---|
| License Number | 01032492A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | RIDGEWOOD |
| State | NY |